Ankylosing spondylitis (AS) is an inflammatory arthritis that mainly affects the spine, causing persistent pain and stiffness. Over time, it can reduce flexibility and range of motion. Treatment typically includes a mix of medication, physical therapy, and complementary approaches to manage symptoms, improve mobility, and slow disease progression.

Medications

Finding the right medication or combination may take time, and treatment is often adjusted to suit each individual’s response.

non-steroidal anti-inflammatory drugs (NSAIDs)
These are often the first medications prescribed. They reduce joint pain by targeting the body’s inflammatory response. Over-the-counter options include ibuprofen and naproxen, while stronger prescription NSAIDs include celecoxib and diclofenac.

NSAIDs are generally safe for short-term use, though higher doses may cause side effects like nausea, bloating, heartburn, or increased blood pressure. Long-term use can elevate the risk of ulcers, kidney problems, or heart issues, and may not be suitable for individuals with certain chronic conditions.

disease-modifying antirheumatic drugs (DMARDs)
DMARDs, such as methotrexate, help calm the immune system and reduce inflammation. Synthetic DMARDs like JAK inhibitors are also used for AS. These drugs are particularly effective in treating inflammation in peripheral joints like knees and hips and may help prevent joint damage.

Possible side effects include nausea, headaches, bloating, and, in some cases, liver function changes or blood cell count alterations when used long-term.

biologics
Biologics are a newer class of DMARDs used when other medications are not effective. These medications reduce inflammation by targeting specific proteins in the immune system.

There are two main types:

  • Interleukin-17 (IL-17) inhibitors, which block inflammatory proteins in the body

  • TNF inhibitors (TNFi), which target tumor necrosis factor-alpha to reduce inflammation

Biologics are given via injection or IV infusion and include drugs like certolizumab, secukinumab, etanercept, adalimumab, infliximab, golimumab, and ixekizumab.

Since biologics suppress immune function, they may increase vulnerability to infections or prolong recovery time from illnesses.

corticosteroids
These medications, such as prednisone, are used less frequently but can provide short-term relief by reducing inflammation. Due to the risk of serious side effects, corticosteroids are not recommended for long-term use.

Physical Therapy

Physical therapy plays a critical role in managing AS. It helps:

  • Relieve pain

  • Improve flexibility and mobility

  • Maintain joint function

  • Prevent further damage

  • Enhance quality of life

Therapy often includes a range of exercises:

aerobic exercises
Activities like walking or cycling improve heart health, lung capacity, and overall endurance.

balance exercises
These strengthen stabilizing muscles and reduce fall risk.

strengthening exercises
Using resistance bands or weights, these movements maintain muscle support around affected joints.

stretching exercises
Target spine and joint flexibility to preserve or enhance range of motion.

A physical therapist will tailor a program specific to your needs and physical capabilities.

Surgery

Most people with AS do not require surgery. However, in severe cases where pain or deformity significantly impacts daily life, surgical options may be considered.

Surgical decisions depend on:

  • Severity of symptoms

  • Location and extent of joint damage

  • Presence of deformities

  • Patient age, health, and lifestyle

Common surgical procedures include:

hip replacement
Damaged hip joints are replaced with artificial components to relieve pain and restore mobility.

laminectomy
A portion of spinal bone is removed to relieve pressure on nerves or the spinal cord.

spinal fusion
Two or more spinal vertebrae are permanently joined to stabilize the spine and relieve pain.

spinal osteotomy
Spinal bones are cut and reshaped to correct posture or structural deformities.

Complementary and Alternative Medicine

In addition to conventional treatments, some individuals explore complementary therapies to ease symptoms.

acupuncture
This traditional method uses fine needles to relieve pain, reduce inflammation, and promote relaxation.

massage therapy
Manual techniques are used to loosen tight muscles, ease pressure, and improve joint movement.

tai chi
This gentle practice combines movement and breath to increase flexibility and reduce discomfort.

yoga
Blending breathing and stretching, yoga helps reduce stiffness, increase strength, and enhance mood.

spinal manipulation
Chiropractic adjustments may not be suitable for AS. Always consult a healthcare provider before pursuing this option.

Living With and Managing Ankylosing Spondylitis

AS can present many challenges, but early and consistent treatment can greatly improve quality of life and slow progression. Left untreated, AS can lead to disability and loss of function.

Daily strategies can also help:

  • Use a grabber tool for reaching high objects

  • Modify home features for safety and accessibility

  • Use assistive devices like a cane when needed

With the right treatment plan and support, many people with AS live full, active lives.

A Quick Review

Treating AS effectively requires a comprehensive approach, including medications, physical therapy, and sometimes complementary therapies. Starting treatment early is essential for managing symptoms and maintaining a good quality of life. In more serious cases, surgical intervention may be needed to address joint damage or spinal issues.